Evidence record
Colorado Made Capitation Payments to Managed Care Organizations After Enrollees’ Deaths
- Jurisdiction
- Colorado
- Publication date
- February 2025
- Source record
- Original document linked
Findings
0
Recommendations
0
No formal recommendations were issued in this record.
Overall conclusion
The audit found that Colorado made unallowable capitation payments to Medicaid managed care organizations for deceased enrollees, resulting in significant financial losses and reporting inaccuracies. The State agency lacked adequate controls and policies to prevent and recover these payments, although it has taken some corrective actions. The audit recommends refunds, improved controls, and policy enhancements to prevent future errors.
Scope
The audit covered Medicaid managed care capitation payments made by the Colorado Department of Health Care Policy and Financing from January 1, 2018, through December 31, 2020. It focused on payments made on behalf of enrollees whose dates of death were recorded in various data sources, including the Social Security Administration's Death Master File and the State's eligibility system, to identify unallowable payments and assess control deficiencies.
Recommendations (0)
This record contains no formal recommendations.